A clot, a close call and a cure for Shirley man

SHIRLEY -- The stomach pain was constant, but Bob Graham chalked it up to muscle strain from raking leaves in his yard the previous day.

A few days later, the pain had become so intense that he could not sleep, so he asked his wife, Pat, to bring him to the hospital. She took him to Emerson Hospital in Concord, and a CT scan immediately revealed that Graham's pain wasn't caused by raking but from a ruptured abdominal aortic aneurysm. A vessel wall had weakened and burst in his aorta, the artery that carries blood from the heart to the rest of the body.

Emerson Hospital vascular surgeon Stephen Hoenig said that if he and his team had not performed an advanced form of treatment on Graham, he would have died.

Graham was told his pain was likely caused by the blood that leaked from his his aorta into his back. He was lucky in that the leak had at least temporarily sealed itself off from the rest of his body.

"A very small clot was acting as a dam, holding back the tide of blood," Hoenig said. "The bleed had sealed itself off. The patient was stable but you never know when he would bleed again. ... At any given moment, he could have opened up."

If that happened, Hoenig said, Graham would have died.

The procedure performed on Graham, known as a percutaneous endovascular aneurysm repair (PEVAR) is minimally invasive and does not require the patient to be put under general anesthesia.

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It is also not a procedure every hospital is currently practicing because of the sheer cost, Hoenig said.

"It was almost like an orchestrated series of events," he said. "Things just fell into place like this had been preplanned."

Graham knows he was lucky. Dr. Hoenig and his team were at the hospital ready to perform surgery on another patient, but Graham was bumped to the top of the list.

"It was almost a good thing I had waited another day," Graham said. "I was told that the doctor was in New York the previous day running a marathon. If I hadn't waited, Dr. Hoenig wouldn't have been there and who knows what would have happened."

Hoenig said he used a slim catheter to insert a custom-made stent graft, often referred to as a fabric tube, within the aneurysm.

By doing this, he said, blood is safely routed through the patient's body. One tiny incision is required around the patient's groin area, he said, and the procedure requires only light sedation.

Graham remembers being awake during the procedure with only the incision area numbed.

"I couldn't see or feel anything because there was a hood over my head, but I knew they were there and I could hear them talking," he said.

The surgery took three hours, he said, and he was in recovery for two more before being transferred to the cardiac care unit, or CCU, in the hospital.

His wife was a trouper during the whole thing, he said, sitting in the waiting room all alone waiting for updates.

Often, Hoenig said, the patient is allowed to leave the hospital the following day with little to no pain.

The traditional "open" surgery that is used in hospitals not equipped to do the new procedure requires a 1- to 2-foot-long incision in the body while the patient is under anesthesia in addition to blood transfusions and a seven-day hospital stay.

That is typically followed by a lengthy rehabilitation process with much greater risks for complications, he said.

Major surgery like that comes with a recovery time of at least three months, he said, and isn't well tolerated by all patients.

Graham remained in the hospital for two days after the procedure because of nausea from the blood that leaked into his back before surgery.

Having survived a diagnosis that has a 90 percent mortality rate, Graham, a retired U.S. Marine MedEvac pilot and high school teacher, said his priorities have never been clearer.

Graham had high praise for staff at the hospital who saved his life.

"They were absolutely wonderful. I can't say enough about them at the hospital. They just treat you like you're a part of their family," he said.

He is spending more time with his wife, and the couple are planning more day trips to Maine and New Hampshire.

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